alleviating the access abyss: palliative care and pain ...university hospital bonn malteser hospital...
TRANSCRIPT
University Hospital Bonn
Malteser Hospital Bonn/Rhein-Sieg
Alleviating the Access Abyss:
Palliative care and pain management
Universitätsklinikum Bonn
Malteser Krankenhaus Bonn/Rhein-Sieg
India: Tripavanthapurim
Universitätsklinikum Bonn
Malteser Krankenhaus Bonn/Rhein-Sieg
Global Palliative Care
Universitätsklinikum Bonn
Malteser Krankenhaus Bonn/Rhein-Sieg
Global Opioid Consumption
https://www.thelancet.com/commissions/palliative-care
University Hospital Bonn
Malteser Hospital Bonn/Rhein-Sieg
IAHPC Opioid Price Watch
Availability, affordability and accessibility of a 30-day treatment
of oral solid morphine (red dots: not available)
https://hospicecare.com/opioids/reports/map/
University Hospital Bonn
Malteser Hospital Bonn/Rhein-Sieg
IAHPC Opioid Price Watch
https://hospicecare.com/opioids/reports/map/
Universitätsklinikum Bonn
Malteser Krankenhaus Bonn/Rhein-Sieg
Lancet Report
Serious Health-related Suffering SHS
Essential package
Costs of essential package
https://www.thelancet.com/commissions/palliative-care
Universitätsklinikum Bonn
Malteser Krankenhaus Bonn/Rhein-Sieg
Lancet Report
https://www.thelancet.com/commissions/palliative-care
Serious Health-related Suffering:
(SHS)
25,6 Mio Decedents
35,5 Mio Non-decedents
6 (to 21) Billion days
5,3 Mio children<15J
Universitätsklinikum Bonn
Malteser Krankenhaus Bonn/Rhein-Sieg
Essential Package
Lancet Report
Medicines
Morphine, others
(comparable to WHO essential medicines list)
Equipment
Oxygen, nasogastric tubes, urinary catheters, pressure-
reducing mattresses, locked safebox, flashlight, adult
diapers
Human resources
Doctors, nurses, social workers /counsellors, psychiatrists,
psychologists, physical therapists, pharmacists,
community health workers, clinical support staff,
volunteers
https://www.thelancet.com/commissions/palliative-care
Universitätsklinikum Bonn
Malteser Krankenhaus Bonn/Rhein-Sieg
Essential Package
Costs
https://www.thelancet.com/commissions/palliative-care
Ruanda
(LIC)
Vietnam
(LMIC)
Mexiko
(MIC)
EP Medicines (US$ / capita) 52 27 122
EP Total (US$ / capita) 219 119 796
Percentage of Gross Domestic Product 0,25% 0,04% 0,03%
Percentage of health expenditures 3,4% 0,6% 0,5%
Percentage of public health expenditures 8,8% 1,0% 1,0%
Children: Morphine for 1 Mio US$ would be sufficient
to relieve SHS in children
University Hospital Bonn
Malteser Hospital Bonn/Rhein-Sieg
US 2015
Palliative care needs covered by opioids: 3147%
Deaths from opioids overdose: 33,000
Overdose deaths/Mio inhabitants: 102.9
Germany 2015
Palliative care needs covered by opioids: 1474%
Deaths from opioids overdose: 223
Overdose deaths/Mio inhabitants: 2.7
Deaths from Opioids Overdose
Häuser et al. Pain Manage 6 (2016) 249-63
Universitätsklinikum Bonn
Malteser Krankenhaus Bonn/Rhein-Sieg
South Africa: Johannesburg
Chris Hani Baragwanath Krankenhaus
Universitätsklinikum Bonn
Malteser Krankenhaus Bonn/Rhein-Sieg
National Guidelines
WHO: Ensuring Balance
Principle of balance in drug control policy
Governments not only have an obligation to prevent drug
abuse, but also to ensure the availability of opioid
analgesics for pain relief and drug substitution therapy
Opioids should be available, accessible and affordable
Guidelines (21) and checklist
http://apps.who.int/iris/bitstream/10665/44519/1/9789241564175_eng.pdf
Universitätsklinikum Bonn
Malteser Krankenhaus Bonn/Rhein-Sieg
Recommendations
Lancet Report
Stewardship
Legislative and normative framework
Public awareness and support
Feedback between global and national policy
Monitoring and evaluation of palliative care
Financing
National universal health coverage platform and packages
https://www.thelancet.com/commissions/palliative-care
Universitätsklinikum Bonn
Malteser Krankenhaus Bonn/Rhein-Sieg
Recommendations
Lancet Report
Delivery
Expansion from cancer or HIV to other diseases
Community involvement
Strong programmes
Resource generation
Training and capacity building
Health systems research and lessons learned
https://www.thelancet.com/commissions/palliative-care
Universitätsklinikum Bonn
Malteser Krankenhaus Bonn/Rhein-Sieg
Uganda: Jinja Hospice